Expert Nursing Tips: How to Deal With Angry Patients

Understanding and dealing with angry patients

Understanding and dealing with angry patients is a challenge for everyone. Registered nurses deal with angry patients every day, regardless of where they work. At times, they may not be aware of how angry certain patients have become or know why their patients are angry. Dealing with any angry patient is never easy, but understanding what anger is and how it is expressed, can help registered nurses to deal with angry patients.

What is anger?

Dictionary.com defines anger as "a strong feeling of displeasure and belligerence aroused by a wrong" and uses it in its obsolete context relating it to "grief" or "trouble". 

Anger reveals displeasure that appears as an expression of an emotion. Depending upon how strong the feelings of anger are, the patient may be able to hide his or her anger from others or begin to express it openly, in terms of antagonistic words, deeds and actions that may affect or endanger his or her life or the lives of other people, including registered nurses and other medical personnel.

Expressions of anger vary and include ire, rage, fury, indignation and wrath, as they may occur in conjunction with nurse-patient relationships.

Ire:

The word ire is used within a limited literary context. Ire expresses a high level or intensity of anger evidenced as a visible expression of feeling. For instance, an angry, male patient's face is flushed and his cheeks appear bright red, as he writes a letter to the hospital director, complaining about the shortage of nurses. He appears to have an elevated blood pressure. This patient is attempting to rectify what is a serious, hospital situation, by being one voice that speaks out.

Rage:

Rage is more serious anger evidenced by the loss of self control. This results from the intensity or violence of strong emotions being experienced inwardly and vented outwardly. For instance, a male patient stands in the middle of the hallway and screams at the nurse assigned to care for him, that he has no intention of being isolated, just because he has been infected with a virus. "It is not my fault!" he insists angrily. In this case, being isolated would save the lives of others.

Fury:

Fury entails an over-mastering, destructive kind of rage that appears to be on the verge of madness or insanity. In this instance, a male patient cannot accept the diagnosis of prostate cancer. He refuses to undergo surgery, reacts violently and starts to destroy things in his room. He gets dressed and storms out of the hospital, without permission from the doctor. Note that any sudden decisions that are made during the time of anger expressed as fury, can have disastrous consequences. In this case, being treated for cancer may save his life.

Indignation:

Indignation is frequently referred to as righteous anger. In this instance, a male patient in his early nineties attempts to express his anger by muttering that he considers his treatment to be unfair. He perceives the nurses as being mean to him and the way they regard him as being shameful. He does not comprehend the reality that he has Alzheimer's disease and will have to live in a locked ward for his own safety and that of his family.

Wrath:

Wrath is extreme anger that invariably leads to the desire or the intent on the part of the patient, to get revenge or to punish someone, for something. In this instance, a male patient has lost a limb because of a flesh-eating, strep infection. He is grieving for his lost limb and filled with wrath. He is determined to take revenge on the nurses and the doctor, because they have not been able to halt the infection or save his limb. He does not realize how serious this kind of an infection is and that by removing his limb, his life may have been saved.

Why are patients angry? Obviously, there can be many reasons why patients are angry. No registered nurse knows every reason for a patient's anger, expressed or unexpressed.

What are patients angry about? Patients can be angry about almost anything and the things that anger them the most are ones that they cannot control or do not understand.

Is this something new and different for patients? No. Anger is a normal human response. Anger is intensified with respect to anything perceived as a life-threatening.

Remember that patients are people and people are often angry about many things, including some that are highly personal, strictly confidential and may be family or work related. What patients are angry about may have absolutely nothing to do with nurses or other caregivers.

Sometimes, anger can be expressed as misdirected anger, targeting registered nurses or other health care givers, even outside of their work environment. On the other hand, there may be justifiable circumstances that trigger anger with respect to patient health care or the medical environment.

What do angry patients do? They may hide their anger or express it in some way. If they are ill, confused or disoriented, their expressions of anger can be magnified or intensified.

What should registered nurses do in order to deal with angry patients?

Maintain your professional composure as a registered nurse. Assume control of the situation, as much as possible. Call for additional assistance, depending upon the situation. Recognize the reality that your patient may be ill, frightened, confused or disoriented and potentially violent.

Protect your patient, other patients and yourself from abuse or injury. Restrain your patient if necessary, so that he does not do senseless damage to the area. If you suspect that your patient has hidden anger, the situation may suddenly become volatile, so be careful with respect to what you say or do. The patient's anger may also escalate, at any time.

Always speak to your patient professionally, quietly and calmly, on a one-to-one basis, using his or her first name. Acknowledge your patient's anger and apologize to him, even if what is happening to him is not your fault. Listen closely to everything that your patient states and observe what he does.

Answer your patient's questions honestly. Assure your patient that he is safe and that you will help him to work through his anger. Do not humiliate him or talk down to him.

Document the situation accurately. Attempt to discern any unknown reasons why your patient is or has become angry.

Notify your patient's doctor with respect to unusual or prolonged bouts of anger. Administer appropriate medications to your patient, as ordered by his doctor.

Attempt to avoid any future situations that may trigger your patient's anger, repeatedly. Obtain further advice from the patient's physician, counselors and family members regarding this bout of anger or any repeated bouts that may occur. Seek short or long term anger management counseling for your patient. Discuss measures to avoid future episodes of anger with other staff members and family members.

Note that you and others may also be angry, with respect to what has happened or is happening with your patient. You will need to deal with your own feelings.

Understanding the different expressions of anger and responding immediately, appropriately and professionally to your angry patient, can help to resolve crises and help to prevent future bouts of anger. As a professional registered nurse, you will gain the respect of your patients, because of your active demonstration of compassion, care and concern with respect to your patient's expressions of anger.